Who cares how alternative medicine works, as long as it does?

I hear this notion regularly and I have repeatedly published about it (even on this blog).

In Germany, people often express it succinctly  WER HEILT HAT RECHT! The argument is so prevalent that I feel like addressing it yet again by publishing a revised version of my Lancet Oncology paper of 2005.

At first glance, the argument seems disarmingly obvious and ethical – above everything else, clinicians must have the welfare of their patients in their minds. All other concerns are secondary.

However, on closer inspection and reflection the argument is not convincing. For the purpose of this discussion, I shall use healing as an example of a SCAM that fulfils the following three criteria:

• it is associated with perceived benefit to some patients;
• it is apparently without harm;
• it is not supported by convincing evidence of efficacy.

Thus, spiritual healing could be replaced, for instance, by homeopathy, Bach Flower Remedies, craniosacral therapy, shark cartilage, etc.

It is obvious that the above argument can apply only, if the treatment in question does not entail meaningful risks. But how do we know it doesn’t? The fact that we are unaware of risks does not mean that none exist. Indeed, none of the above-named treatments are entirely free of adverse effects. Even healing has been associated with unwanted effects. They may be relatively mild and rare, but in the absence of any reporting schemes, this fact is less than conclusive: absence of evidence is not evidence of absence of an (adverse) effect.

The above argument can also be viewed as an endorsement for use of SCAM. If widespread, such endorsements could lead to many patients trusting the many unsubstantiated claims made about SCAM. This would mislead patients into using such therapies as alternatives to conventional treatments—the promotion of alternative cancer cures is rife with recommendations for abandoning conventional cancer therapy, and the effects have repeatedly been shown to be disastrous. Used as an alternative, even the most harmless treatment can become positively life-threatening.

The above argument clearly presupposes that the treatment in question works. But what is meant by this phraseology? Certainly there is no convincing trial evidence that spiritual healing works for cancer or indeed any other condition. “It works” therefore could mean that the treatment helps some patients via a placebo response. There is, of course, nothing wrong with patients benefiting from placebo effects. But do we need placebo treatments to generate a placebo response? The answer is no; even effective therapies will evoke a placebo response. In other words, patients don’t need healing or any other such treatment to profit from a placebo effect. It follows that administering pure placebos to sick patients means cheating them out of an essential element of an effective therapy.

If patients feel better after consulting a healer, they most likely respond to factors like empathy, sympathy, and time provided to them by that therapist. Again, there is absolutely nothing wrong with such a response. To the contrary, responsible orthodox healthcare professionals should cultivate the attitudes that generate it. By directly or indirectly sending our patients to healers to benefit from empathy, etc, we effectively delegate these core qualities of a good therapeutic relationship to others. But delegating empathy to SCAM practitioners would be a most serious mistake for modern medicine to make.

Healers often charge £100 or more per session. Because a placebo response is a free add-on to any well-administered treatment, this seems an unjustifiably high amount of money. Financial exploitation is a subject not much talked about in SCAM – in our recent new book, we included a whole chapter on this issue. We all should think twice before endorsing exploitation.

Perhaps the most detrimental effect of the above argument is outside the realm of medicine. Spiritual healing, like astrology, clairvoyance, mind-reading, etc, is not merely implausible it is mystical nonsense based on ideas that are demonstrably incorrect. Promotion of such nonsense undermines rationality and supports the growth of anti-science and superstition in our society at large. Arguments like that above therefore amount to an endorsement of anti-science. They might sound liberal, tolerant and politically correct but, in truth, they undermine the foundation of rational thinking, hinder progress and lead us back to the Dark Ages.